Adding a Corticosteroid or Switching to Another Anti-VEGF in Insufficiently Responsive Wet Age-Related Macular Degeneration

Cagdas Kaya,¹ Souska Zandi,^1,3 Isabel B Pfister,^1,2 Christin Gerhardt,^1,2 Justus G Garweg<sup>1,2

1</sup>Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland; ²Department Ophthalmology, University Hospital Bern, Bern, Switzerland; ³Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

Correspondence: Justus G Garweg
Berner Augenklinik am Lindenhofspital, Bremgartenstrasse 119, Bern CH - 3012, Switzerland
Tel +41 31 311 12 22
Fax +41 31 311 14 33
Email Justus.garweg@swiss-eye-institute.com

Purpose: To compare the effect of adding a corticosteroid or switching to another anti-VEGF treatment in patients with exudative age-related macular degeneration (eAMD) with persisting intraretinal fluid on anti-VEGF monotherapy.
Methods: This retrospective, interventional case series involved 43 pseudophakic eyes with eAMD and persistent intraretinal fluid on anti-VEGF treatment that switched treatment to a combination of Ozurdex^® or Triamcinolone and anti-VEGF therapy (group 1) or to another anti-VEGF agent (group 2). The number of injections, time to re-injection, change in central retinal thickness (CRT), and best-corrected visual acuity (BCVA) from 12 months prior to 12 months after switch to third-line therapy were defined as primary outcomes.
Results: Whereas the treatment demand was reduced (from 8.8±2.2 to 4.6±2.9 injections; p=0.001) and the re-injection interval extended in group 1 (from 1.5±0.4 months to 4.4±3.8 months; p=0.001), these parameters did not change in group 2 (7.4±1.6 to 7.3±2.2; p=0.90 and 1.7±0.3 months to 1.9±0.8 months; p=0.75). Mean CRT decreased from 455.7±30.1 and 427.6±36.0μm (groups 1 and 2, respectively) to 359.1±38.2 and 303.1±44.4μm (intergroup p=0.03). The mean baseline BCVA of 62.6±3.8 letters (group 1) and 63.0±1.9 letters (group 2) remained stable under therapy in both groups (intergroup p=0.67).
Conclusion: In eyes with eAMD with persistent intraretinal fluid on anti-VEGF monotherapy despite frequent re-injections, corticosteroids achieved a similar functional and morphological outcome over 12 months as switching to another anti-VEGF therapy, but with a reduced injection burden. In selected cases, corticosteroid treatment may thus be an option for third-line therapy in refractory exudative AMD.

Keywords: exudative age-related macular degeneration, Ozurdex, dexamethasone intravitreal implant, triamcinolone, ranibizumab, aflibercept